Document Type

Dissertation

Degree

Doctor of Nursing Practice

Major

Nursing

Date of Defense

7-10-2024

Graduate Advisor

Brittania Phillips

Committee

Brittania Phillips

Kimberly Werner

Michelle Waller

Abstract

Abstract

Problem: Patient aggression, restraint usage and assaults against healthcare workers have numerous negative health outcomes. Patient aggression and restraint usage on inpatient psychiatric units can be identified early with imminent violence predicative tools such as the Brøset Violence Checklist (BVC), where patient de-escalation interventions can subsequently occur.

Methods: This quality improvement project was conducted using a cohort design with a retrospective and prospective chart review. The IHI PDSA model was used for this project. The BVC was administered to male and female patients ages 18 to 64 years old on the adult inpatient psychiatric unit during the implementation period. Data collection included the patient demographics, BVC scores, number of interventions, and restraint type, patient restraint injuries, patient to patient assaults, and staff assault injuries.

Results: During the pre-implementation period, a total of 329 patients were admitted, 12 patients were restrained, and 40 restraint episodes occurred. Post-implementation 317 patients were admitted, 18 restrained and 55 restraint episodes occurred. Total restraints increased by 2%, chemical restraints increased by 6%, manual holds increased by 2%, lock seclusion increased by 7% and 4-point restraints decreased by 17%. Patient-restraint injuries decreased by 6%, patient-to-patient assaults decreased by 1% and staff injuries increased by 2%.

Implications for Practice: Patients at-risk for aggression were identified by the BVC. Further research is needed into the use of the BVC and restraint reduction.

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Additional Files

GRMC BVC.pdf (68 kB)
BVC benefits handout.pdf (71 kB)
intro BVC handout.pdf (52 kB)

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